Authorization Representative

Job description

Job Details Coordinates insurance benefits verification and secures prior authorizations for surgical procedures, diagnostic testing, medications, referrals, and related services. Interprets payer-specific authorization requirements and ensures compliance with health plan protocols. Supports revenue cycle operations by performing functions that promote accurate claims submission and timely reimbursement from insurance carriers and patients. Job Description: Summary: Coordinates insurance benefits verification and secures prior authorizations for surgical procedures, diagnostic testing, medications, referrals, and related services. Interprets payer-specific authorization requirements and ensures compliance with health plan protocols. Supports revenue cycle operations by performing functions that promote accurate claims submission and timely reimbursement from insurance carriers and patients. Job Duties: - Collaborates with physicians and provider office staff in secure the appropriate authorization, referral based on medical necessity and the patients’ treatment plan. - Performs medical necessity review to ensure procedures and diagnoses meet payer requirements. - Obtain authorizati...